Sexual|Reproductive Health

Learning From Failure 2022

In 2019 and 2020, CARE published Learning from Failures reports to better understand common problems that projects faced during implementation. Deliberately looking for themes in failure has helped CARE as an organization and provides insight on what is improving and what still needs troubleshooting. This report builds on the previous work to show what we most need to address in our programming now.
As always, it is important to note that while each evaluation in this analysis cited specific failures and areas for improvement in the project it reviewed, that does not mean that the projects themselves were failures. Of the 72 evaluations in this analysis, only 2 showed projects that failed to deliver on more than 15% of the project goals. The rest were able to succeed for at least 85% of their commitments. Rather, failures are issues that are within CARE’s control to improve that will improve impact for the people we serve.
To fully improve impact, we must continue to include failures in the conversation. We face a complex future full of barriers and uncertainties. Allowing an open space to discuss challenges or issues across the organization strengthens CARE’s efforts to fight for change. Qualitative analysis provides critical insights that quantitative data does not provide insight into the stories behind these challenges to better understand how we can develop solutions.
CARE reviewed a total of 72 evaluations from 65 projects, with 44 final reports published between February 2020 and September 2021 and 28 midterm reports published between March 2018 and October 2020. Seven projects had both midterm and final evaluations at the time of this analysis. For ease of analysis, as in previous years, failures were grouped into 11 categories (see Annex A, the Failures Codebook for details).

Results
The most common failures in this year’s report are:
• Understanding context—both in the design phase of a project and refining the understanding of context and changing circumstances throughout the whole life of a project, rather than a concentrated analysis phase that is separate from project implementation. For example, an agriculture project that built it’s activities assuming that all farmers would have regular internet access, only to find that fewer than 10% of project participants had smartphones and that the network in the area is unreliable, has to significantly redesign both activities and budgets.
• Sustainability—projects often faced challenges with sustainability, particularly in planning exit strategies. Importantly, one of the core issues with sustainability is involving the right partners at the right time. 47% of projects that struggled with sustainability also had failures in partnership. For example, a project that assumed governments would take over training for project participants once the project closed, but that failed to include handover activities with the government at the local level, found that activities and impacts are not set up to be sustainable.
• Partnerships—strengthening partnerships at all levels, from government stakeholders to community members and building appropriate feedback and consultation mechanisms, is the third most common weakness across projects. For example, a project that did not include local private sector actors in its gender equality trainings and assumes that the private sector would automatically serve women farmers, found that women were not getting services or impact at the right level.
Another core finding is that failures at the design phase can be very hard to correct. While projects improve significantly between midterm and endline, this is not always possible. There are particular kinds of failure that are difficult to overcome over time. Major budget shortfalls, a MEAL plan that does not provide quality baseline data, and insufficient investments in understanding context over the entire life of a project are less likely to improve over time than partnerships and overall MEAL processes.
Some areas also showed marked improvements after significant investments. Monitoring, Evaluation, Accountability, and Learning (MEAL), Gender, Human Resources, and Budget Management are all categories that show improvements over the three rounds of learning from failures analysis. This reflects CARE’s core investments in those areas over the last 4 years, partly based on the findings and recommendations from previous Learning From Failure reports. Specifically, this round of data demonstrates that the organization is addressing gender-related issues. Not only are there fewer failures related to gender overall, the difference between midterm and final evaluations in gender displays how effective these methods are in decreasing the incidence of “failures” related to engaging women and girls and looking at structural factors that limit participation in activities.
Another key finding from this year’s analysis is that projects are improving over time. For the first time, this analysis reviewed mid-term reports in an effort to understand failures early enough in the process to adjust projects. Projects report much higher rates of failure at midterm than they do at final evaluation. In the projects where we compared midline to endline results within the same project, a significant number of failures that appeared in the mid-term evaluation were resolved by the end of the project. On average, mid-term evaluations reflect failures in 50% of possible categories, and final evaluations show failures in 38% of possible options. Partnerships (especially around engaging communities themselves), key inputs, scale planning and MEAL are all areas that show marked improvement over the life of the project.
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Urban Community Health Workers in Afghanistan

Building strong relationships and trust between community health workers and the communities they serve prior to public health emergencies can help ensure continuity of health seeking behaviors during times of crisis. When health services dropped during COVID-19 lockdowns, women community health workers increased services 25%.

Health-seeking significantly decreased during COVID-19 lockdown due to fear of contracting the virus, and
many of the health posts in CHWs homes were shut down at this time. In contrast, CARE-supported urban CHWs,
particularly in Kabul and Balkh, were able to continue service provision in their homes due to the strong trust
they had built with the communities they served and their recognized leadership among community members
and as part of the health system. The relationship between CHWs and local communities was complemented by
CARE’s efforts to quickly provide CHWs with personal protective equipment and build capacity on WHO
protocols for COVID-19 screening, detection, and referral of cases as well as risk communication and
community engagement. During COVID-19 lockdown, the CHWs also continued provision of SRH, GBV services,
and referrals to midwives at community-based health centers run by CARE. In addition to maintaining service
delivery, the CHWs also began offering counseling and support to local women using mobile phones. Read More...

Menstrual Hygiene and Health Development Impact Bond

This report is focused on the experience, knowledge, attitude, and practices of menstrual health and hygiene. This involved generating understanding about the MHH knowledge, attitude, and practices among schoolgirls and adult women. It also aimed at creating an understanding of the experience of women and girls within the social norms and economic constraints and forwarding recommendations for future improvement. Read More...

Building sustainable and scalable peer-based programming: promising approaches from TESFA in Ethiopia

This research was written by Pari Chowdhary, Feven Tassaw Mekuria, Dagmawit Tewahido, Hanna Gulema, Ryan Derni, and Jefrey Edmeades.

In Ethiopia's Amara region, girls encounter child marriage at a high rate. They are also less able to negotiate sex or use family planning. With the purpose of improving their lives, CARE's TESFA program delivered reproductive health and financial savings curriculum to married girls through peer-based solidarity groups to 5,000 adolescent girls. This was divided into 3 interventions: sexual and reproductive health, economic empowerment, and a combination of both. Participants reported improvement in both areas. Four years after TESFA, 88% of groups communicated meeting without continued CARE's assistance, and some of the girl participants created new groups following the TESFA model. Also, some girls that did not participate in TESFA, replicated the model to create their own groups. Despite this, there is still in question who contributed to this sustainment and scale-up of groups.

Original article: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01304-7
Originally published by Biomedcentral and is republished under the creative commons 4.0 license (https://creativecommons.org/licenses/by/4.0/ - https://creativecommons.org/publicdomain/zero/1.0/). Read More...

RAPPORT D’ANALYSE SITUATIONNELLE, CARTOGRAPHIE SOCIALE ET ANALYSE DU POVOIR SUR COVID-19 DANS LA ZONE DE SANTE DE KATWA

Une de composante de ce projet de prévention contre la propagation de la pandémie COVID-19 dans la zone de santé de Katwa, consiste à conduire une analyse situationnelle plus approfondie dans les aires de santé ciblées par le projet dans le but de pouvoir déterminer les connaissances, les perceptions, les attitudes et les pratiques des membres de la communauté y compris des partenaires étatiques vis de la pandémie elle-même et de ses mesures de prévention. Par conséquent, l’exercice consiste à ouvrir des débats sur la Covid-19 et d’autres épidémies, à faire prendre conscience du problème et à amorcer le dialogue entre les principales parties intéressées à différents niveaux pour des stratégies de lutte plus appropriées.
La réalisation de cet exercice a comporté quatre (4) moments clés à savoir :
1. Atelier d’analyse situationnelle, cartographie sociale et analyse du pouvoir avec les acteurs clés
2. Enrichissement et collecte des données de l’atelier à travers des Focus groups dans les 9 Aires de santé
3. La phase d’analyse, compilation et rédaction du rapport (première version) des données
4. Restitution, capitalisation des amendements et des résultats de l’analyse.
Ce rapport relate le cheminement méthodologique et les résultats synthèse des travaux réalisés, ils seront ensuite complétés lors de l’atelier de restitution par les résultats complets des focus groups réalisés au sein de la communauté bénéficiaire dans la ZS de Katwa. Read More...

Strengthening Approaches for Maximizing Maternal and Newborn Health (SAMMAN)

The use of the family planning method enables people to achieve their desired number of children and helps to reduce unintended and high-risk pregnancies and unsafe abortions, which contributes to saving the lives of many women. The main objective of this study is to examine the post-intervention impact on the use of family planning methods among married women of reproductive age in Nepal. Read More...

Women at the last mile: How investments in gender equality have kept health systems running during COVID-19

Even before COVID-19, investments in health systems—and especially female health workers—were too low. In 2019 the world had a gap of 18 million health workers. Two years and fifteen million deaths later, we have at least 26 million fewer health workers than we need. , This leaves us severely underprepared for future pandemics and other major shocks to the health system, including conflict and climate change. We must invest in health systems that don’t just meet the needs of today, but that are also resilient in the face of future shocks.

Pandemic preparedness requires gender equality: equal recognition, support, and fair pay for ALL health workers. Globally, 70% of health workers are women, but half of their work is unpaid. We must do more to support these health workers. The glimmers of success in COVID-19 built on previous investments in women health workers, their skills, and equality in health systems. Pre-existing investments in equality helped systems respond to COVID-19. Increased investments will build better resilience for the crises that come next.

This report highlights case studies and lessons learned from 20 countries during COVID-19. The evidence shows that we must invest in gender equality in health systems to prepare for and respond to the next pandemic. Health worker training is not enough. Focusing only on health workers working within the formal health system is not enough. We need to work for equality.

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Impact, Influence, and Innovation: Reflecting on 10 Years of the CARE-GSK Frontline Health Worker Initiative

In recognition of their critical role in health linkages and systems strengthening, CARE and GSK established a decade long strategic investment in frontline health workers (FHW) and community health workers (CHW) in 2011 called the Frontline Health Worker Initiative. Following 10 years of partnership and programming, this report explores the resulting impacts, influence, and innovation. It synthesizes reach and impact data from 13 programmes across the 9 countries included in the Frontline Health Worker Initiative between 2011 and 2021. The countries included in this initiative are Afghanistan, Bangladesh, Cambodia, Cameroon, Chad, Laos, Myanmar, Nepal, and Togo.
The data presented here is specific to the communities in which CARE delivered sexual and reproductive health, maternal and child health, nutrition, and sanitation programming with GSK’s support. The analysis is designed to identify the changes in overall health outcomes that occurred at a population level. While these findings do not necessarily imply causation, CARE’s efforts have likely reasonably contributed towards these changes within the specific communities.
The Frontline Health Worker initiative has achieved these results across multiple development and humanitarian contexts – including slow-onset and sudden shocks, conflict, and most recently the COVID-19 pandemic. Many of these results were only made possible through the long-term investment from GSK and scalable actions that were implemented across all nine countries. Critically, the Frontline Health Worker Initiative established platforms, networks and health service capacity-building that served as a catalyst for CARE to pivot towards the response to the COVID-19 pandemic quickly in the communities where these projects exist.
Learnings from this programme will serve to strengthen CARE’s private sector partnership models for future programmes to build resilience and achieve health impact in communities. Read More...

ON THE FRONTLINE: Lessons on health worker empowerment through the COVID-19 pandemic response

Around the world,frontline and community health workers serve to connecthealth services, commodities, and informationwiththose who need them. Equippedwith the relevant skills and community trust, theycanstrengthen health systems by bridginggeographic and financial accessibility gaps for rural, hard-to-reach, and vulnerable populations through last-mile health delivery. When integrated into national and local healthcare systems, community health workers can additionally help patients navigate complex systems of care and ensure care continuity across services. Historically during times of health crises, global governments and organizations have often relied on community health workforces as frontline responders to deliver life-saving care to disproportionate l y affected populations. The 2020 COVID-19 pandemic was no exception, with many countries mobilizing their existing community health worker programs or initiating new ones to assist with pandemic response . Leveraging lessons learned through its decades long support and implementation of frontline and community health worker initiatives across 60 countries, CARE developed guidelines for community-level pandemic response and disease prevention during this time. In June 2020, CARE partnered with Abbott to launch a one-year in-depth primary care response to the COVID-19 pandemic Read More...

End line assessment of GSK supported Community Health workers (CHW) initiative in Sunamganj district, Bangladesh

In spite of improvement in maternal and child health, the Sylhet division continues to have the poorest indicators in Bangladesh. Higher mortality for both mother and child and poor utilization of healthcare services still exist in the Sylhet division. Sunamganj is one of the remotest areas in Bangladesh and belongs to the Sylhet division having the poorest maternal and child health status. Since December 2012, CARE Bangladesh together with GSK and other key stakeholders has been implementing a Community Health Workers (CHWs) Initiative, which aims to address the lack of skilled human resources in remote and underserved unions of Sunamganj district. The overall goal of the CHW initiative is to improve maternal and child health outcomes in underserved/remote and poor communities of Bangladesh by increasing their access to quality health care services. Through a unique model of Public-Private Partnership (PPP), the project developed 319 Private CSBAs who are providing maternal and child health services including primary treatment of Non-Communicable Diseases (NCDs) like diabetes and hypertension in the entire Sunamganj district. To do a robust measurement in terms of assessing maternal, neonatal and child health (MNCH) related knowledge and practices as well as documentation of learning of these innovative initiatives, icddr,b conducted a baseline study in 2012 and end-line assessment in 2018. Read More...

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